| NPI | 1952700858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29611) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2022-03-08 |